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NPI Code Detail

MEDICARE: CHASE RYAN KORNEGAY M.D.

MEDICARE: CHASE RYAN KORNEGAY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician24482OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356480826
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHASE RYAN KORNEGAY M.D.
Provider Business Mailing Address
First Line : 2100 LAKESIDE BLVD
Second Line : STE 250
City : RICHARDSON
State : TX
Zip : 75082-4351
Country : US
Telephone Number : 972-422-5941
Fax Number : 972-881-4390
Provider Business Practice Location Address
First Line : 4100 INTERNATIONAL PLZ
Second Line : SUITE 600
City : FORT WORTH
State : TX
Zip : 76109-4820
Country : US
Telephone Number : 817-334-0530
Fax Number : 817-877-0350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 01/26/2018

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